Virologist Oyewale Tomori explains what Nigeria, where the virus is endemic, should do to prepare for an outbreak
There has been an outbreak of smallpox cases in several countries that are not endemic to the virus. Smallpox is caused by an orthopoxvirus that is closely related to the virus that caused the smallpox. Monkeypox is an animal virus that occasionally infects humans after being bitten or scratched by a monkey or other animal. It does not usually spread easily between humans, and usually only in close contact. As of May 13, 110 confirmed cases and 205 suspected cases have been reported in more than 12 countries. Virologist Oyewale Tomori explains what Nigeria, where the virus is endemic, should do to prepare for an outbreak.
Does Nigeria manage to contain monkeypox?
Since the first human case of smallpox in 1970 in the Democratic Republic of the Congo (DRC), the disease has been reported in several other countries in Central and West Africa: Cameroon, Central African Republic, Ivory Coast. , Gabon, Liberia, Nigeria, Republic of the Congo and Sierra Leone. Most infections are found in the DRC.
Ghana has not reported any human cases of smallpox. However, the source of 47 confirmed and probable cases of monkeypox in 2003 in the United States was found in small mammals.
These include rodents, rope squirrels (Funiscuirus sp), tree squirrels (Heliosciurus sp), giant shrimp rats (Cricetomys sp), porcupines (Atherurus sp), dormice (Graphiurus sp) and imported striped mice (Hybomys sp). of Ghana.
This was the first time human smallpox was reported outside Africa. Of the cases of the current outbreak in several European countries, none appear to have any contact with cases in Africa.
In Nigeria we probably don’t know how much disease we have, because surveillance is not what it should be. We are definitely missing many of the cases of smallpox in rural areas.
From September 2017 to the end of April 2022, Nigeria reported a total of 558 suspected cases with 231 (41.4%) confirmed. This year, from January 1 to April 30, we reported 46 suspected cases and confirmed 15 of seven states. No deaths have been reported this year.
Disease surveillance in Nigeria has been affected by the COVID-19 pandemic.
Take Lassa fever, for example. Nigeria confirmed 1,181 cases of Lassa fever in 2020, the year COVID-19 arrived in 2021, the number of confirmed cases dropped significantly to 510, less than half the number confirmed in 2020.
Now that the effect of COVID-19 is waning and things are back to normal, the number of confirmed cases of Lassa fever during the first four months of 2022 stands at 759.
The same situation has been reported for surveillance and reporting of other diseases. Excessive concentration and the change or resources to respond to COVID-19 and the fear of contracting COVID-19 in healthcare facilities contributed to the low figures reported between 2020 and 2021 for a number of diseases, such as yellow fever and measles.
There has also been a drop in the delivery of routine vaccines to Nigerian children. In Oyo State, Nigeria, measles coverage fell from 77.0% in 2019 to 64.6% in 2020, while yellow fever vaccine coverage fell from 74.5% in 2019 at 58.6% in 2020.
What to do to prepare for the next outbreak?
We need to anticipate what will happen and prepare.
It is unlikely to be a mutation because the monkeypox virus is a DNA virus, which does not change much and is much less prone to mutation and the generation of variants, such as SARS-CoV-2, which is an RNA virus.
But to be sure, we should do our sequencing to know exactly what we are facing and to be able to compare with what they have in Europe right now.
We also need to make communities aware that this is happening. We now know that a resident of the United Kingdom who arrived in Nigeria on April 20, 2022 and traveled to the states of Lagos and Delta left Lagos on May 3, 2022 and arrived in the United Kingdom, where it was confirmed the diagnosis of monkeypox on May 6, 2022..
This information is enough to warn us that someone became infected with monkeypox by contact with a Nigerian while in Nigeria. We should track contacts to determine if there are more cases.
It should also be used as an opportunity to get information to our people and let them know that we still have this disease and to offer guidelines for prevention and control.
If someone has a rash, this person should be referred to the hospital for further investigation and hospital staff should establish procedures for the prevention and control of infections, including the use of gloves and gloves. other protective materials.
To avoid becoming infected and becoming a source of infection for other people, healthcare workers dealing with infected people should take standard precautions to prevent and control infections: hand washing, personal protective equipment. , respiratory hygiene, cough label and safe injection practices. that of awareness and preparation, but not panic.
How is the monkey’s smallpox spread?
The virus can spread through direct contact with the body fluids of an infected person or with objects contaminated with the virus, such as bedding or clothing. In addition, it can be transmitted by respiratory drops during direct and prolonged face-to-face contact. It is not easily transmitted as SARS-CoV-2. This is good news. Therefore, it is important to reduce contact with those who are infected.
Should the world be worried? What about treatment?
Of course, we should be concerned. The disease can cause the death of one in 10 infected people and can spread very quickly. The symptoms (fever, malaise and headache) of chickenpox are more severe than those of chickenpox.
The other cause for concern is that no specific treatment or vaccine is available for monkeypox infection. In the past, the smallpox vaccine has been shown to be 85% effective in preventing monkeypox. But smallpox has been eradicated, so the vaccine is no longer widely available.
However, outbreaks can be controlled. The first step is to prevent infections. This can be achieved through public health awareness campaigns to reduce the risk of animal-to-human transmission. Key messages would include the fact that people should avoid contact with sick or dead animals that could harbor the virus, especially in areas known as hot spots for monkeypox.
Other precautions include ensuring that infected people are isolated and that health workers caring for sick people wear gloves and protective equipment.
Are there many strains?
So far, no, it seems that there are only two types: the Congo Basin and the West African strains.
It is unlikely to have strange mutations as happened with SARS-CoV-2, which causes COVID-19. Remember that smallpox is a DNA virus. It is not an RNA virus, which mutates often generating variants of concern.
Oyewale Tomori, a member of the Nigerian Academy of Sciences
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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